• J. Thorac. Cardiovasc. Surg. · Oct 2022

    Endobronchial ultrasound-guided bipolar radiofrequency ablation for lung cancer: A first-in-human clinical trial.

    • Tsukasa Ishiwata, Yamato Motooka, Hideki Ujiie, Terunaga Inage, Alexander Gregor, Masato Aragaki, Zhenchian Chen, Tomonari Kinoshita, Laura Donahoe, Jonathan Yeung, Marcelo Cypel, Marc de Perrot, Andrew Pierre, Gail Darling, Thomas Waddell, Shaf Keshavjee, Prodipto Pal, and Kazuhiro Yasufuku.
    • Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
    • J. Thorac. Cardiovasc. Surg. 2022 Oct 1; 164 (4): 1188-1197.e2.

    ObjectivePercutaneous radiofrequency ablation (RFA) is a therapeutic option for lung tumors. However, percutaneous approaches have limited access to central lung regions and a relatively high complication rate. To overcome these limitations, a needle-type bipolar RFA device compatible with an endobronchial ultrasound (EBUS) bronchoscope was developed. The aim of this pilot study was to evaluate the immediate-term safety and ablation zone of lung tumor EBUS-guided RFA.MethodsThis was an ablate-and-resect study in patients scheduled for surgical resection of clinical stage I or II lung cancer or metastatic lung lesions ≥1 cm that were accessible using an EBUS bronchoscope. The RFA electrodes were placed within the lung nodule using EBUS guidance followed by ablation. Bronchoscopy and contrast-enhanced computed tomography were performed to evaluate for post-RFA complications. The resected lung underwent pathological assessment to characterize the ablation zone.ResultsA total of 5 primary lung cancers were ablated in 5 separate patients; no patients with metastatic lesions were recruited. For a total energy of 4 kJ (n = 3), 6 kJ (n = 1), and 8 kJ (n = 1) delivered, the ablation time was a mean of 13.8 (range, 10.3-16.0) minutes, 8.4 minutes, and 15.6 minutes, respectively, and the maximum ablation diameter was a mean of 1.8 (range, 1.3-2.1) cm, 2.7 cm, and 2.6 cm, respectively. No immediate post-RFA complications were observed.ConclusionsEBUS-guided bipolar RFA can ablate lung tumors using real-time ultrasound guidance. EBUS-guided RFA might ultimately represent a minimally invasive therapy for lung cancer in patients unable to tolerate surgery. Longer-term safety will need to be evaluated.Copyright © 2022 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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